Best Care Always Initiative – Powerful Leadership & …fpnl.co.za/web/files/presentations2012/Dr...
Transcript of Best Care Always Initiative – Powerful Leadership & …fpnl.co.za/web/files/presentations2012/Dr...
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Best Care Always Initiative – Powerful Leadership & Management
Dr Sharon Vasuthevan Forum for Professional Nurse Leaders
Conference 8 May 2012
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100 000 Lives Campaign
• The Best Care Always (BCA) initiative has been a wonderful opportunity to implement evidence based practice in the management of: – Hospital acquired infections (HAI) – Central line infections, surgical
site infections, catheter associated urinary tract infections & ventilator assisted pneumonias
– Prevention of patients dying from heart attacks (Acute myocardial infarction)
• The bundles have been developed by Institute for Healthcare Improvement(IHI) through a peer reviewed process and has been implemented internationally with significant results.
• The bundles were part of the 100 000 lives, now 5 million lives campaign and was first introduced in South Africa by the Life Healthcare group
• BCA was established to create SPREAD and ensure that private and public institutions in South Africa are implementing the bundles
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Bundles
• Each bundle is made up of a set of elements (actions/preventive measures)
• Philosophy of the bundles is that you apply every element of the bundle on every patient every time
• The elements if implemented, will ensure improved patient outcomes
• The bundles are assessed by the relevant registered nurses in the specific units
• A sample of the patients are observed and files reviewed and the results published
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Implementation & Spread
• Data is audited manually and the plan is to use tablets/ipads going forward to capture same
• The data is captured on an electronic system - LHC uses Infoquest and monthly statistics are generated
• New Bundles available include:
– Antimicrobial stewardship
– Caesarean Section - Surgical Site Infections
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Learnings • The bundles work if all the stakeholders are
informed
• Implementation must be a way of life
• Results must be communicated and showcased to create awareness
• A non punitive approach improves reporting
• Analysis of data and action plans are necessary
• Statistics must be accompanied by commentary
• Publishing is important
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Other Projects
• Adverse drug events
• Transforming Care at the Bedside
• Patient Safety
• Magnet Principles
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Adverse Drug Events • Prevention of adverse drug events (ADEs) by
implementing medication reconciliation • ADE is the harm caused by the drug or harm from
the use of the drug • Medication errors are mishaps that occur during
prescribing, transcribing, dispensing, administering or monitoring of the drug – some times called near misses or close calls
• ADEs managed like a bundle of preventive measures have been developed by IHI
• Requires clinical leadership
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Transforming Care at the Bedside
• Focus: Increasing Nurses’ time in direct patient care
• TCAB principles – Engaging Senior Leadership
– Selecting Units & Forming the team
– Engaging the frontline staff
– Engaging Physicians
– Setting Goals
– Generating Ideas
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Patient Safety
• Patient safety for Selected Indicators – Pressure Ulcer Rate
– Iatrogenic Pneumothorax rate
– Central Venous Catheter related bloodstream infection
– Post Operative Hip Fracture Rate
– Post Operative Complication rate - various
– Accidental puncture or laceration rate
• Requires clinical leadership
• Involvement from senior nurse leadership team
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Magnet principles
• Awarded by the American Nurses Credentialing Centre (ANCC), an affiliate of the ANA
• Principles – Transformational Leadership
– Structural Empowerment
– Exemplary Professional practice
– New Knowledge, Innovation and Improvements
– Empirical Quality Results
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Model for Improvement
• Ask the following questions? – What are we trying to accomplish?
– How will we know that a change is an improvement?
– What changes can we make that will result in improvement?
• 4 Point Plan (PDSA) – Plan
– Do
– Study
– Act
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Don’t waste time reinventing the
wheel!
Call for Clinical Leadership & Excellence
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Leadership
• Leadership is a “personal” or “individual” activity and is therefore not a defined role, and is not tied to a position of authority.
• Rather, it is a characteristic of an individual and can occur at any level within an organization.
• Each professional nurse has the potential and perhaps the responsibility to provide leadership within our practice, our institutions, our professional organizations, our communities and our profession
Grossman and Valiga (2009)
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Leaders
• Proactive about formulating goals they are passionate about.
• Shape ideas; act to change the way people think about what is desirable, possible, and necessary.
• Act to develop fresh approaches to long standing problems and open issues to new options.
• Take risks, challenge “sacred cows,” challenge existing assumptions and ask “why not?”
• Create excitement in their work. • Concerned with how decisions affect others. • Promote development and creativity of followers. • Internal “sense of self.”
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Leadership & Management • A person can be both an effective manager and an effective
leader.
• Much can be achieved when leaders are in positions of authority and have both the skills and resources to move an organization forward.
• People want to work in an organization that is going places.
• Organizations tend to be well managed by an effective leader.
• Leadership is a complex, multifaceted phenomenon that does not “just happen;” it is deliberative and can be learned
• “Managers are people who do things right. Leaders are people who do the right thing.” (Warren Bennis and Burt Nanus )
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Clinical Leadership in Action
• Facilitating the clinical development of others • Coaching others in interpreting, forecasting, and
responding to patient transitions • Bridging the gaps in patient care • Negotiating conflict with angry and demanding
patients and/or families; from control to connection and understanding
• Building and preserving collaborative relationships
• Transforming care delivery systems
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Attributes of Clinical Leaders
• Creative and innovative about clinical practice
• Highlight best practice
• Influence the multidisciplinary team
• Respect the work of others
• Support new clinical initiatives
• Adopt a transformational leadership style
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Clinical Excellence • Means striving to be the very best you can be
in everything you do or setting high standards
• Clinical excellence is about achieving a level of mastery
• People are recognized with respect for their acumen, knowledge, and their scholarship approach to clinical practice
• True experts are identified for the profession
• Experts publish their work
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Principles of Clinical Excellence
• Discipline – drawing on knowledge and experience in practice in a systematic way that is of the highest calibre
• Choreography – successfully balancing competing demands in our pursuit of goals
• Responsibility – Acknowledging that we have done well or poorly and blaming no one
• Caring – consistently demonstrating a concern and compassion for others and ourselves
• Scepticism – not accepting everything blindly, open mind approach
• Perseverance – continually striving to fulfil a goal o • Passion – being inflamed by our work
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Strive for Excellence
• Excellence can be attained if you….
– Care more than others think is wise
– Risk more than others think is safe
– Dream more than others think is practical, and
– Expect more than others think is possible
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Where can we start?
• Competencies for clinical specialists
• Education to support clinical leadership
– Post graduate diploma – nurse specialist
– Clinical Masters – advanced nurse specialist
• Limited period for experienced nurses in specialist units
• Clinical leadership career ladder
• Write our stories and then move into scientific publishing
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What’s in it for me? (WIIFM)
• Career growth
• Records to defend nursing practice
• Scientific systems and processes to manage clinical practice
• Publishing best practice
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Improved Patient Care
• Clinical leadership and the quest for clinical excellence will lead to the development of a defined improved nursing care
• Clear perceptions and generalizations about nursing
• Change the focus of nurse leaders from administration to clinical focus